Rate of malignancies in breast abscesses and argument for ultrasound drainage

Background: Biopsy of a breast abscess wall has been performed for years without evidence. Aspiration of breast abscesses has been increasing in popularity without widespread acceptance. Methods: A 10-year retrospective review of 206 surgical biopsies after incision and drainage of breast abscesses. A literature review of breast abscess treated with ultrasound-guided aspiration. Results: Over 10 years, 4.37% (9/206) patients were diagnosed with malignancy in the abscess cavity wall tissue. None of the 197 patients with a negative biopsy returned with breast cancer. Single, multiple, and combined aspiration success rates of 79.8% (364/458), 11.0% (50/458), and 90.9% (482/532) with surgical intervention necessary in 9.1% (50/532). Ultrasound versus hand guidance (92.5% versus 81.9 %, P < .01) improved success rate. Conclusions: The rate of associated malignancies with breast abscess is very low and does not warrant mandatory surgical drainage. The use of ultrasound-directed aspiration of breast abscesses is effective and should be first-line therapy.